Provider Demographics
NPI:1902902737
Name:SAUNERO-NAVA, LILIANA C (MD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:C
Last Name:SAUNERO-NAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SOUTHWAY SUITE C
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 SOUTHWAY AVE STE C
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2703
Practice Address - Country:US
Practice Address - Phone:208-743-8585
Practice Address - Fax:208-746-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6696174400000X
IDM-6696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8042367Medicaid
ID20009839Medicare PIN
IDF99808Medicare UPIN
1132377Medicare PIN